Medicaid expansion passes after heated politicking; 470,000 more Michiganders to get coverage

Aug. 27, 2013

A group of nearly 100 protesters, many affiliated with the AFL-CIO, came to the state Capitol Tuesday to urge the Senate to take a vote to support Medicaid expansion. / Kathleen Gray/Detroit Free Press

LANSING — It took two votes and eight hours of mostly closed-door politicking and vote wrangling, but the state Senate approved a plan late Tuesday to expand Medicaid health care coverage to 470,000 low-income Michiganders.

The historic 20-18 vote makes Michigan the 25th state in the nation to go ahead with the Medicaid expansion as part of the federal Affordable Care Act, according to the Kaiser Family Foundation. Five more states are debating the issue and 21 have decided not to go ahead with the expansion.

The plan almost fell apart when Sen. Patrick Colbeck, R-Canton, decided not to vote the first time the bill came up, leaving it with a 19-18 tally, one vote shy of passage.

A bill needs 20 votes to pass. If Colbeck, an ardent opponent of the expansion, had voted no as expected, a 19-19 tie would have happened. And Lt. Gov. Brian Calley would have had to cast the tie-breaking vote. He was prepared to support the expansion.

But the Senate immediately voted to allow a reconsideration of the vote, and went into recess to see whether they could muster the one vote needed to break the impasse. Several hours later, an amendment was offered and Sen. Tom Casperson, R-Escanaba, switched his no vote to a yes, giving it a winning 20-18 margin. The amendment basically says that hospitals can’t charge Medicaid patients more than 115% of what they charge Medicare patients.

Democrats were united in their support of the expansion, even with changes in the bill that shift some of the cost of health care coverage to the recipients.

“We know we all pay for uncompensated care in this state. But with this expansion, 320,000 people will be covered in the first year; 470,000 by 2020,” said Sen. Gretchen Whitmer, D-East Lansing. “Our uninsured population will drop by 46%.”

“The Healthy Michigan plan emphasizes personal responsibility,” Gov. Rick Snyder said after the vote. “Those covered by the plan will be required to share in the costs through premiums. There also will be incentives for them to take responsibility for their lifestyle choices and to maintain or improve their health.

“Healthy Michigan will make our state healthier and stronger. It also will save money for the state’s taxpayers and job providers, help control medical costs, improve the state’s business climate, and boost our economy. All of these are crucial to continue Michigan’s comeback.”

The Senate failed to get the two-thirds vote necessary to give the bill immediate effect, meaning it won't become law until April 1. But health officials said they're not worried about the logistics of the three-month delay and hope the Senate will reconsider the vote to give the bill immediate effect.

“This bill is about reform. It is a national model,” Kahn said. “The taxes in the Affordable Care Act are billions of dollars. And for us in Michigan, it will be $2 billion siphoned from our people, and we’re going to bring that back to the state.”

Walker, R-Traverse City, called the Affordable Care Act one of the worst pieces of legislation passed by Congress, but said it’s been validated by the U.S. Supreme Court.

“Whether we like it or not, Obamacare is here to stay,” he said, explaining why he was voting yes on the bill. “But I am hopeful for a day when Obamacare is no longer the law of the land.”

Republicans have been split on the issue with many adamantly opposed to anything having to do with what they call Obamacare.

“Is now the time in our nation’s history to expand federal government entitlement spending?” asked Sen. John Moolenaar, R-Midland. “Today (Tuesday) we have the opportunity to say no to more crushing federal debt that burdens our children and grandchildren. And no to the greatest expansion of government in our time.”

Colbeck, who sponsored an alternative bill that would have basically scrapped Medicaid for a state-subsidized program that included high deductibles for low-income Michiganders, said passing the expansion was “unconsciounable.”

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“Hitching our wagon to this Obamacare train is a high-risk venture,” he said. “If this goes into effect, 30% of our population is going to be on Medicaid, and then 70% is going to be paying for 30%.”

About 100 demonstrators, frustrated that it’s taken so long for the Senate to take up the expansion, crammed the chamber’s gallery as the Senate began session at noon Tuesday, at times chanting “Time to vote.”

“Patriot Pat” and “Freedom Fred,” who were with the AFL-CIO and dressed in Revolutionary War garb, led the protesters and tried to present a cracked teapot to Senators who are against the expansion.

The Medicaid expansion would extend to people who fall within 133% of the federal poverty level and would be fully paid for by the federal government through 2017. The federal contribution would drop to 90% by 2020.

Currently, most of the state’s 1.9 million Medicaid recipients are children, adults with disabilities and the extremely poor. The expansion would open up the program to many low-income working Michiganders — the so-called working poor — who have no health insurance, but who will be required to get coverage under the Affordable Care Act.

The bill requires the additional recipients to contribute 5% of their out-of-pocket medical costs. After 48 months, that co-pay would increase to 7% or the recipient could purchase insurance on the health care exchange.

However, if a person who falls in that poverty level is determined to be “medically frail” — either with a chronic disease, mental illness or are unable to complete the daily tasks of life — they would remain at the 5% co-pay.

The federal government will have to grant waivers to Michigan for two of the provisions of the bill, the creation of health savings accounts for Medicaid recipients and language that allows recipients to choose between a health care exchange or Medicaid benefits after 48 months. But state health officials have said they’re confident the waivers will be granted.

The issue has been bubbling up in the Legislature since the spring when Snyder announced his support of the expansion.

Lynne Lindsay, a breast cancer survivor from Mason, said she was encouraged not only for her own health care, but for her co-workers at Speedway as well.

“It is such a relief that I can go back to work and let people know that they will be able to get health insurance,” she said.

But Scott Hagerstrom, executive director of the conservative Americans for Prosperity – Michigan, said his group will be spending considerable resources to let voters know how their Senators voted.

“As the failures of this law pile up, I have no doubt that some of the lawmakers who today (Tuesday) supported this proposal will regret that decision.,” he said. “Our state leaders can no longer blame the failures of President Obama’s health care law on Washington, DC, politicians alone.”